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Autistic spectrum disorders

Page last reviewed: 13/07/2011

Some people with autistic spectrum disorder (ASD) grow up without their condition being recognised, but it's never too late to be diagnosed. Once diagnosed, adults may access a range of autism-specific services, such as social groups that may be available locally.

Adults with ASD will need to consider where they'd like to live, and whether they might need any support at home.

Where to live

Adults with ASD can live in all types of housing. For example, some people may be suited to a residential care home, while others may prefer to live on their own and receive home support. Others live completely independently.

Supported living can work very well for some adults with ASD. They can choose a place to live in the community, they can live alone or with other people, and get the support they need. They may need 24-hour care, or they may only need help with important day-to-day tasks for a couple of hours each week.

Some adults with ASD may not want to move out of the family home. Caring for anyone with a disability can be challenging, and parents may need additional support.For information on services available go to the HSE below



Finding a job

It can be difficult for people with ASD to find employment. For example, they may find the work environment too noisy, or travelling to work is too stressful because of the crowds. Sudden changes in routine can be upsetting.

However, in the right job and with the right support, people with ASD have much to offer. They are often accurate, reliable and have a good eye for detail. Being in a working environment can help the individual's personal development tremendously.

Some people will need their working environment to be adapted for them. It is important to match someone's skills to the right job and offer ongoing support. Visit the Irish Society for Autism website to find help with getting a job.


Page last reviewed: 13/07/2011

The causes of autistic spectrum disorders (ASD) can be described in two ways:

  • Primary ASD(also known as idiopathic ASD): no underlying medical condition can be found to explain the symptoms of ASD.
  • Secondary ASD: there is an underlying medical condition that is thought to be responsible, or partially responsible, for the symptoms of ASD.

90% of cases of ASD are primary. The other 10% are secondary.

Primary ASD

Researchers have studied four possible factors in the cause (or causes) of primary ASD:

  • Genetic factors: certain genetic mutations may make a child more likely to develop an ASD.
  • Environmental factors: during pregnancy, a child may be exposed to certain environmental factors that could increase the risk of developing an ASD.
  • Psychological factors: people with ASD may think in certain ways that contribute towards their symptoms.
  • Neurological factors: specific problems with the development of the brain and nervous system could contribute towards the symptoms of ASD.

Each of these factors is discussed in more depth below.

Genetic factors

Most researchers believe certain genes that a child inherits from their parents could make them more vulnerable to developing an ASD. This is for two reasons.

Firstly, cases of ASD have been known to run in families. If an older child develops an ASD, there is a 5-6% chance that any new child born to the same parents will also develop an ASD.

If an identical twin develops an ASD, there is a 60% chance that the other twin will develop the condition.

At present, no specific genes linked to ASD have been identified. There are currently no tests that can screen for 'ASD genes'. 

Environmental factors

Some researchers have argued that ASD are not primarily caused by genes, but also by environmental factors. The theory is that a person is born with a pre-existing vulnerability to an ASD, but the ASD develops only if that person is exposed to a specific environmental trigger.

Some suggested environmental factors include:

  • the mother having a viral or bacterial infection during pregnancy,
  • maternal smoking during pregnancy,
  • paternal age (the age of the father),
  • air pollution, and
  • pesticides.

There is evidence to support the first three factors listed above.

Women exposed to a rubella infection during pregnancy are estimated to have a 7% risk of giving birth to a child with an ASD. Women who smoke daily throughout early pregnancy are 40% more likely to give birth to a child with an ASD.

New fathers who are above 40 are estimated to be six times more likely to father a child with an ASD than fathers under 40. This is possibly because a man's genetic material is more at risk of developing mutations as he gets older.

Researchers are currently studying the possibility of air pollution and pesticides as causes for ASD, under what is known as the CHARGE study. However, it will probably be several years before there is definitive information on environmental factors.

Psychological factors

Much of the research into the possible psychological factors behind ASD is based around a concept known as 'Theory of Mind' (TOM).

TOM is a person's ability to understand other people's mental states, i.e. to recognise that each person you meet has their own set of desires, intentions, beliefs, emotions, perspective, likes and dislikes. Or to put it simply, TOM is the ability to see the world through another person's eyes.

It is thought that most children without ASD have a full understanding of TOM by around the age of four. Children with ASD develop a limited or non-existent understanding of TOM. This may be one of the root causes behind their problems with social interaction.

Neurological factors

Much of the research into the neurological factors that may be associated with ASD has focused on the part of the brain known as the amygdala.

The amygdala acts as a kind of 'switchbox' between two parts of the brain:

  • Cerebral cortex: the part of the brain that processes sensory information, such as what you see, smell and hear. The cerebral cortex is also responsible for all of the higher functions of the brain, for example thought, language and problem solving.
  • The limbic system: the part of the brain that regulates your emotion.

The amygdala 'chooses' emotional responses from your limbic system and relays them to your cerebral cortex. This means that your emotions match the situation that you are in. 

Brain imaging studies carried out in people with ASD suggest that the connections between the cerebral cortex, the amygdala and the limbic system have become scrambled.

As a result, people with ASD may suddenly experience an extreme emotional response when seeing a trivial object or event. This may be a reason why people with ASD are fond of routines: they have found a set pattern of behaviour that does not provoke an extreme emotional response. It may also explain why they often become very upset if that routine is suddenly broken.

This confusion of emotional responses may also explain why children with ASD are interested in topics that most children would find boring, such as train timetables.

Another area of research into ASD has focused on special types of brain cells called mirror neurones, which were first discovered in the 1990s.

Mirror neurones are thought to enable us to copy other people's actions. At the most basic level, mirror neurones may give a baby the ability to return their mother's smile.

As a person becomes older, the mirror neurones create more complex pathways in the brain that may be involved in many of the higher brain functions, such as:

  • language,
  • the ability to learn from others, and
  • the ability to recognise and understand other people's emotional states (Theory of Mind).

Brain imaging studies have found that mirror neurones do not respond in the usual way in people with ASD.

So mirror neurone dysfunction may be responsible for the difficulties children with ASD have in terms of language, social interaction and some types of learning.

Secondary ASD

Some conditions that are known to cause symptoms of ASD are listed below:

  • Fragile X syndrome: an uncommon genetic condition that is more common in boys. It is estimated that one in every 3,600 boys and one in every 6,000 girls are born with the condition. Children with Fragile X syndrome usually develop certain facial and bodily characteristics, such as a long face, large ears and flexible joints.
  • Tuberous sclerosis: a rare genetic condition that causes multiple, non-cancerous tumours to grow throughout the body, including the brain. It is estimated that one in every 6,000 children is born with tuberous sclerosis.
  • Rett syndrome: a rare genetic condition that almost always affects girls. It causes symptoms of ASD, and difficulties with physical movement and development. It is estimated that one in every 20,000 girls is born with Rett syndrome.


MMR (measles, mumps and rubella) is a vaccine that prevents measles, mumps and rubella by making the body produce antibodies that fight off the viruses.
Genes contain information that you inherit from your parents, such as eye or hair colour. They are carried by chromosomes.
The brain controls thought, memory and emotion. It sends messages to the body to control movement, speech and senses.

Page last reviewed: 13/07/2011

The characteristics of autistic spectrum disorder (ASD) can vary both from person to person and across different environments. They can also be different for the same person at different times in their life. That is why autism is usually referred to as a spectrum disorder.

The traits of ASD can be divided into three main groups. They are:

  • social interaction,
  • social communication, and
  • social imagination.

The first characteristics of ASD can sometimes be seen in a child who is under the age of two. However, in other children, the condition may not be picked up until they are much older.

Social interaction

A person who has an ASD may find it hard to relate to other people. They may:

  • seem distant or detached,
  • have little or no interest in other people,
  • find it difficult to make friends,
  • not seek affection in the usual way, or resist physical contact, such as kissing and cuddling,
  • find it difficult to make eye contact with other people,
  • want to have social contact but have difficulty knowing how to initiate it,
  • not understand other people's emotions, and have difficulty managing their own emotions, and
  • prefer to spend time alone.

Social communication

A person who has ASD may have difficulty using verbal and non-verbal skills, and some people may remain non-verbal throughout their lives. People with ASD who do speak, may use speech in an over-complicated way, using odd phrases, or odd choices of words. They may also make up their own words or phrases, and use more words than are necessary to explain simple things. Someone with ASD may also have difficulty:

  • expressing themselves well,
  • understanding gestures, facial expressions, or tones of voice,
  • using gestures to communicate, and
  • understanding instructions.

Some people with ASD may develop echolalia, where they repeat words that have little meaning, or repeat what has been said to them.

Social imagination

Children with ASD may:

  • have limited imaginative play,
  • play the same games over and over, or play with games designed for children younger than themselves,
  • get upset if their daily routines are interrupted in any way, or
  • show repetitive behaviours, such as hand flapping or spinning.

In addition, children and adults may develop obsessions, for example, with specific objects, lists, timetables or routines.

Sensory difficulties

Most people with ASD also have sensory difficulties. This means that they may be oversensitive to specific things like touch, certain textures, light levels, or sound. Sensory difficulties can also lead to problems with movement. A person with ASD may appear clumsy or have an unusual way of walking.

Asperger syndrome

Asperger syndrome is another form of ASD. People with Asperger syndrome will generally not have a learning disability and are often of average, or above average, intelligence. They will usually have fewer problems with language development but may still experience difficulties with social communication.

Asperger syndrome is often diagnosed later in children and sometimes their difficulties may not be recognised and diagnosed until adulthood. This can cause a delay in getting appropriate support for the individual and their family.

Page last reviewed: 13/07/2011

Autistic spectrum disorders (ASD) are a range of related developmental disorders that begin in childhood and persist throughout adulthood.

ASD can cause a wide range of symptoms, which are grouped into three broad categories:

  • Problems and difficulties with social interaction, such as a lack of understanding and awareness of other people's emotions and feelings.
  • Impaired language and communication skills, such as delayed language development and an inability to start conversations or take part in them properly.
  • Unusual patterns of thought and physical behaviour. This includes making repetitive physical movements, such as hand tapping or twisting. The child develops set routines of behaviour, which can upset the child if the routines are broken.

There is currently no cure for ASD, but there are a range of treatments that can improve the symptoms listed above.

Types of ASD

The term 'spectrum' is used because the symptoms of ASD can vary from child to child, and from mild to severe.

In very broad terms, there are three main types of ASD:

  • Autistic disorder, sometimes known as 'classic autism'.
  • Asperger syndrome.
  • Pervasive Developmental Disorder - Not Otherwise Specified (PDD-NOS), which is also known as 'atypical autism'.

Autistic disorder

Children with autistic disorder usually have significant problems with language, social interaction and behaviour. Many children with autistic disorder will also have learning difficulties and below-average intelligence.

Asperger syndrome

Children with Asperger syndrome have milder symptoms that affect social interaction and behaviour. Their language development is usually unaffected, although they often have problems in certain areas of language. For example, understanding humour or figures of speech, such as 'she's got a chip on her shoulder' or 'it's raining cats and dogs'.

Children with Asperger syndrome usually have above-average intelligence. Some children are skilled in fields requiring logic, memory and creativity, such as maths, computer science and music. (But only 1 in 200 children are exceptionally skilled, so-called 'autistic savants').

Pervasive Developmental Disorder - Not Otherwise Specified

PDD-NOS can be thought of as a 'diagnosis of exclusion'. It is used for children who share some, but not all, of the traits of autistic disorder and/or Asperger syndrome.

Most children with PDD-NOS have milder symptoms than children with autistic disorder, but they do not share the good language skills and above-average intelligence associated with Asperger syndrome.

How common are autistic spectrum disorders?

ASD are uncommon but not rare. It is estimated that 1 in every 100 children has an ASD.

ASD are more common in boys than girls. Boys are three to four times more likely to develop an ASD than girls.

Are rates of ASD rising?

The number of diagnosed cases of ASD has increased over the past two decades, but this does not necessarily mean that the condition is becoming more widespread.

Some experts argue that the rise in diagnosed cases may be due to health professionals getting better at diagnosing cases correctly.

In the past, many children with an ASD may have been incorrectly labelled as 'slow', 'difficult' or 'painfully shy', and not given the treatment they needed.

Some campaigners believe that the rise in cases is due to childhood vaccination programmes:

  • A side effect of the MMR (mumps, measles and rubella) vaccine. This claim has often been made in Ireland.
  • A side effect of a mercury-containing compound called thiomersal, which is used as a preservative in some vaccines. This claim is often made in the US.

The MMR vaccine has been investigated extensively in a number of major studies around the world, involving millions of children. Researchers have found no evidence of a link between MMR and ASD.

Thiomersal has also been extensively studied. No evidence of a link to ASD has been found. Furthermore, thiomersal was removed from vaccines in the US after 1999, yet the rates of ASD have continued to rise in the US.


The outlook for children with ASD usually depends on how severe their symptoms are and, especially, their level of intelligence.

Children with mild to moderate symptoms who have average or above-average intelligence often grow up to be independent adults with jobs, long-term relationships and children.

Children with more severe symptoms who have below-average intelligence are unlikely to be able to live as independent adults. They may need additional care and assistance for the rest of their lives. However, there is no reason why they cannot enjoy a good quality of life.

Page last reviewed: 13/07/2011

As autistic spectrum disorders (ASD) can cause such a wide range of symptoms, there are many different ways that those symptoms can be grouped.

For parents, it is useful to know the signs and symptoms of ASD that are related to your child's stages of development.

Early signs of ASD: 6-18 months

Though it can be difficult for parents to detect, most children with ASD begin to show signs and symptoms between 6 and 18 months old. These signs and symptoms are explained below.

  • Your baby does not follow your gaze. For example, when you look at your watch, a non-ASD baby would copy you and look at your watch as well. Alternatively, your baby does not look at objects that have been pointed out to them.
  • Your baby has no happy expression when they look at you.
  • Your baby does not 'babble', i.e. respond in a 'back-and-forth' manner when you talk to them.
  • Your baby does not seem to recognise or respond to your voice, yet is aware of other sounds, such as a bell ringing or a dog barking.
  • Your baby shows little interest in drawing your attention to things by pointing to them or pulling your hand towards them.
  • Your baby rarely, or never, makes gestures such as pointing or waving.

Signs of ASD in pre-school children

The signs and symptoms of ASD usually become more apparent as your child gets older.

Problems with language will become more noticeable. It is likely that your child will begin to have difficulty with social interaction. They will also show unusual patterns of behaviour.

The signs and symptoms that often develop during this age are explained below.

Language development

Your child may have delayed speech, or not speak at all. Most children are able to construct two word sentences, such as 'ball... want' or 'me. drink' by the age of two.

Delayed language development does not usually affect children with Asperger syndrome, but their speech may be affected in other ways. For example, it may sound very monotonous, flat and/or unusually fast.


Your child may have little interest in playing with toys in an imaginative way, yet they play in a repetitive manner.

For example, rather than pushing a toy car across the floor, your child may concentrate on spinning one of the wheels on the car only. Or, rather than using blocks to build an object, they line the blocks up in order of size or colour.

Children with ASD often prefer to play with household objects such as string, pens or keys, rather than toys. They are happy to play alone for hours without needing supervision or attention.

Social interaction

Many children with ASD often appear to look straight through someone. They have little or no awareness of other people.

Your child may have little interest in other children of the same age, or taking part in shared activities.

Some children with ASD may try to form friendships with children but then behave inappropriately, such as suddenly kissing or hitting another child. Or they are unable to understand concepts such as taking turns.


Many children with ASD develop a repetitive pattern of physical behaviour. These patterns are known as sterotypies.

Examples of sterotypies include:

  • flicking their fingers,
  • flapping their hands,
  • rocking back and forth,
  • persistent and unexplained sniffing, and
  • licking objects.

Many children with ASD develop strict routines, such as having to watch a certain cartoon at a certain time, or having to watch their favourite DVD from beginning to end, including all of the ending credits. If these routines are disrupted, the child may have a severe temper tantrum or act in a self-harming way by banging their head or biting their own skin.

Children with ASD often seem unaware of pain and injuries that would prompt other children to seek attention from their parents. Many parents with ASD children notice that their child has a cut or a bruise, yet the child seems happy.

Children with ASD may suddenly become upset and distressed at certain sounds, such as a vacuum cleaner or a motorcycle, or the sudden appearance of bright lights.

Children with ASD often develop a strong dislike for certain foods. This is usually based on the texture of the food rather than the taste. For example, they may refuse to eat soft foods that dissolve in the mouth, or hard foods that need vigorous chewing.

Signs and symptoms of ASD in school-age children

Some children with mild to moderate ASD may see an improvement in their symptoms as they grow older. Sometimes, attending school gives them an opportunity to learn the social and communication skills that come naturally to non-ASD children.

Children with more severe ASD may find school an increasingly stressful environment. This can trigger episodes of disruptive and difficult behaviour.

Signs and symptoms that can develop in older children and teenagers are explained below.


Though most children with autistic disorder or PDD-NOS improve their language skills, specific difficulties with language may persist, such as:

  • referring to themselves as 'you', 'she' or 'he' rather than 'I',
  • repeating words and phrases, 'parrot-fashion', that they have just heard, or have learnt from watching a film or TV programme,
  • speaking in pre-learned phrases, such as 'I want it now' or 'Where are we going', rather than putting together individual words to form new sentences,
  • their speech has an unusual rhythm, stress or tone, and
  • being unable to start or join in with a conversation unless it is about specific topics that interest them, such as dinosaurs or trains.

In older children with Asperger syndrome, problems with their use and understanding of language often become more apparent. They include:

  • talking 'at' somebody, rather than having a two-way conversation,
  • being unable to adapt the tone and content of their speech to different social situations. For example, speaking very formally at a party and then speaking to total strangers in a familiar way, and
  • taking people's speech literally, and being unable to understand humour, sarcasm, metaphors or figures of speech.

Social interaction

Older children with ASD often have additional problems at school because they do not understand how to interact socially.

This lack of understanding occurs in a variety of ways. For example, they do not realise that people usually relate to their teacher differently to how they relate to their classmates.

A child may have little interest in issues and activities that are popular with other children, such as music, fashion, sport or going out.

Many children with ASD are not aware that they are intruding into other people's personal space. However, they can become extremely upset if they feel that their own personal space is being invaded.

All of these factors often make it difficult for your child to make friends with children of the same age. However, some children with ASD do manage to form relationships with younger children or adults.


The child with ASD is likely to need strict routines as they get older. Many ASD children develop a highly specific interest in a particular subject or activity, which usually involves collecting, numbering or listing.

This can range from a usual childhood activity, such as collecting football stickers (though children with ASD often pursue the interest much more intensely than other children) to activities or subjects not normally associated with childhood, such as an interest in train timetables or reading old computer manuals.

Children with Asperger syndrome often do well at academic subjects that involve facts, figures and logic. But they may struggle with subjects that require abstract thought, such as English Literature or Religious Education.


Hyperactivity is a higher than normal level of activity and restlessness.

Page last reviewed: 13/07/2011

There is currently no cure for autistic spectrum disorders (ASD). However, there are a range of specialist education and behavioural programmes (often known as interventions) that have proved effective in improving the skills of children with ASD.

There are many different types of interventions for ASD, so it is often hard to judge which one will work best for your child.

The American Academy of Pediatrics recently published an 'intervention checklist', which laid out what it judged to be the most important principles and components for effective interventions. These are outlined below.

  • The intervention should be intensive. Your child should be actively involved for at least 25 hours a week, 12 months a year.
  • The intervention should have a low teacher-to-student ratio (i.e. small classes). This is to ensure that your child has plenty of one-to-one interaction with the teacher and that any group work is done in small teams of students.
  • The intervention should involve family members, with a particular emphasis on parent training.
  • The intervention should provide opportunity for interaction with other children without ASD. This so that your child reaches certain developmental goals.
  • The intervention should be highly structured, i.e. based on a series of set routines that your child will hopefully be happy to adopt.
  • The intervention should contain opportunities for your child to apply any newly learnt skills in new environments and situations. For example, visiting new places, or meeting with people your child does not know.

Any intervention should focus on important aspects of your child's development. These are:

  • communication skills, such as the ability to start conversations,
  • social interaction skills, such as the ability to understand other people's feelings and then respond to them,
  • cognitive skills, such as encouraging imaginative play, and
  • academic skills, the 'traditional' skills that a child needs in order to progress with their education, such as reading, writing and maths.

Some widely used interventions for ASD are explained below.

Applied behavioural analysis (ABA)

Applied behavioural analysis (ABA) is based on two goals:

  • Breaking down skills (such as communication and cognitive skills) into small tasks, then teaching those tasks in a highly structured way.
  • Rewarding and reinforcing positive behaviour while discouraging and redirecting inappropriate behaviour.

ABA programmes usually take place in the home. They consist of 40 hours a week of intensive therapy over two to three years.

An ABA programme is usually delivered by:

  • the programme consultant, who devises and oversees the programme, and
  • the programme team, which usually consists of at least three therapists who alternate in working with your child.

The programme team will work with your child on a one-to-one basis in a number of two- to three-hour sessions. The team will try to teach your child by breaking skills down into smaller tasks. These tasks are then taught in a repetitive and structured way, with a particular emphasis on praising your child and reinforcing positive behaviour.

An ABA programme usually begins with simple tasks, such as prompting your child to clap their hands. When your child responds, the team member will help reinforce that response by giving them verbal praise or giving them their favourite toy.

Over time, these small tasks will build up into more complex skills that will help with your child's development.


TEACCH is a type of educational intervention that places great emphasis on structured learning by using visual prompts. Research has found that children with ASD often respond better to information that is presented visually.

TEACCH is often delivered at special day centres, but you can also receive training so that you can continue the intervention activities in your own home.

Speech and language therapy (SLT)

Speech and language therapy is a type of skills training designed to improve your child's language skills, which can improve their ability to interact with others socially.

The therapist uses a number of techniques, such as visual aids, stories and toys, to improve communications skills, such as:

  • listening skills,
  • attention skills,
  • the ability to understand the social and/or emotional context of specific language. For example, being able to tell when the person who is speaking is happy or upset, and
  • the ability to understand non-literal language, such as metaphor or figures of speech.


Many of the interventions mentioned above take a lot of time and labour, and can cost a significant amount of money.


There is no available medication to treat the core symptoms of ASD, but medication can treat some of the related symptoms, such as:

  • repetitive thoughts and behaviour, and
  • aggressive behaviour, such as tantrums or self-harming.

The most widely used medication is the serotonin reuptake inhibitors (SSRIs) class of antidepressants, which work by changing the levels of a chemical called serotonin in the brain. Serotonin is known to affect behaviour and mood.

Examples of SSRIs include: 

  • fluoxetine, and
  • paroxetine.

Some children with ASD who are taking SSRIs can suddenly have a sharp rise in serotonin levels. This can trigger a group of side effects known as serotonin syndrome.

Symptoms of mild to moderate serotonin syndrome include:

  • confusion,
  • agitation,
  • muscle twitching,
  • sweating,
  • shivering and
  • diarrhoea.

If your child exhibits any of the above symptoms, stop their medication and seek immediate advice from your GP or out of hours service.

Symptoms of severe serotonin syndrome include:

  • a high temperature (fever) of or above 39.4ºC (103ºF),
  • seizures (fits),
  • irregular heartbeat, and
  • unconsciousness.

If your child has any of these severe symptoms, call 999 and ask for an ambulance.

Complementary and alternative medicines (CAM)

A number of studies have found that most parents have tried at least one type of complementary and alternative medicine (CAM) to improve their child's symptoms.

Examples of suggested CAMS to treat ASD include:

  • special diets, such as 'gluten-free' diets,
  • vitamin supplements,
  • the use of anti-fungal medication, and
  • chelation therapy, which uses medication or other agents to remove metal, in particular mercury, from the body.

There is little or no evidence to suggest that any of these approaches are effective, and some may even be potentially dangerous.

In terms of diet, do not make changes to your child's diet without first consulting your GP.

It is strongly recommended that you do not try chelation therapy as there is no evidence of its effectiveness. It is based on a theory that mercury is responsible for the symptoms of ASD. But this theory is not shared by mainstream ASD experts, and it is potentially dangerous.

Risks associated with chelation therapy include:

  • high temperature,
  • headache,
  • nausea,
  • vomiting,
  • kidney damage, and
  • liver failure.

One child is reported to have died as a result of chelation therapy.

If you are considering a CAM, look out for certain claims and signs that suggest that the treatment may be unsound. These are as follows:

  • Treatments that are based on overly simplified scientific theories. For example, the theory that ASD is caused by mercury in the body.
  • The treatment is claimed to effectively treat a wide range of unrelated symptoms.
  • Treatments that claim to offer dramatic results or the possibility of a cure.
  • Treatments that rely on unpublished case reports rather than carefully designed studies.
  • Treatments that claim to have no risks or side effects.


Counselling is guided discussion with an independent trained person, to help you find your own answers to a problem or issue.
Hyperactivity is an unusually high level of activity and restlessness.

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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